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Hirsutism in Women with PCOS

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Updated May 28, 2014

Hirsutism in women can be extremely distressing. Unfortunately, it's also one of the most common symptoms of polycystic ovary syndrome (PCOS). The excess production of androgens (male hormones, such as testosterone) is responsible for the extra hair growth, which can appear in places such as the face, neck, chest, back and toes. These days, a woman has a plethora of options available to her -- from over-the-counter products to professional services to prescription medications -- to tend to what she may find an embarrassing problem. Each method has its ups and downs, and it's important for a woman to determine what works best for her.

Shaving

Shaving cuts the hair at the skin's surface, leaving a blunt edge. This does not actually thicken or darken the hair, as is commonly thought. However, the blunt edge of the hair does tend to be noticeable, which makes it appear that way. Because shaving only cuts the hair, it needs to be done frequently to maintain a hair-free appearance. To minimize skin irritation, use a sharp blade and a moisturizing shaving cream or body wash prior to shaving.
Pros: easy to do from home; relatively cheap
Cons: time-consuming; needs to be done frequently, can be irritating to the skin; can cause ingrown hairs

Waxing

Waxing involves applying a layer of wax to the surface of the skin and hair. A cloth is applied to that layer of wax then quickly removed, pulling the hair out of the hair shaft. It can be done using a home waxing kit purchased at the drugstore, or at a salon.
Pros: relatively cheap; can be done at home or by a professional; lasts about 3 weeks
Cons: painful; not permanent; can cause ingrown hairs; at-home waxing kits can be difficult to use

Depilatory Creams and Bleaches

Depilatory creams dissolve hair using a combination of chemicals, while bleaches remove the pigment from the hair, making it less visible. Simply apply the product to the areas you wish to treat, and leave on for the amount of time directed before washing off. Due to the risk of skin irritation, it's recommended that you test the cream on a small area of skin before using it.
Pros: simple to use; relatively cheap; easy to obtain
Cons: may cause irritation or stinging; may need to do frequently; can be time-consuming

Electrolysis

During electrolysis, a small needle is inserted into the hair follicle, and a small current of electricity is applied to kill it. While considered a permanent form of hair removal, hair that is darker or thicker may need several treatments to completely kill the hair follicle. Make sure to seek the services of an electrologist who has completed national testing to become a certified. It is also helpful to check with the American Electrology Association to see if the practitioner has remained certified in his/her practice.
Pros: safe and permanent; won't negatively affect the skin
Cons: some women consider it painful; may take several treatments to achieve permanent hair removal; expensive

Laser Hair Removal

During laser hair treatment, a physician will apply an intense beam of laser light to the area being treated. While not permanent, laser hair treatment will remove hair for much longer periods of time than waxing or other forms of hair removal. This form of treatment is most successful in patients with lighter skin tones and dark hair color. Make sure to use a physician who has performed this procedure many times with good success rates. Prior to the procedure, you will meet with the doctor to discuss your medical history and any medications that you may be taking, which may affect the hair removal process. It is recommended that you shave 2 to 3 days prior to the treatment, and avoid waxing, plucking or sun exposure for several weeks prior.
Pros: long-term effect
Cons: stinging sensation during the procedure; possibility of side effects including redness, crusting, blistering scarring and swelling of the skin; pigment changes of the skin; expensive

Medications

For women with PCOS, there are some medications that work to reduce the amount of circulating androgens, thus reducing excess hair growth. Oral contraceptives (birth control pills) may help, or the doctor may prescribe an antiandrogenic medication, such as Spironolactone. Spironolactone inhibits the testosterone secreted by the body, and also competes for hormone receptors in the hair follicles. Receptors are sites on cells that allow hormones or chemicals to bind to them, creating a reaction. In this case, if another chemical is at a receptor site, androgens cannot bind to it or stimulate the reaction that causes hair growth.

Another medicine that works in the same fashion is Flutamide, though it is not typically used due to the effect that it has on the liver. If you are taking this medication, it is important to follow up with doctor-recommended blood tests to help detect any liver problems early on.

Vaniqa (eflornithine) is a prescription cream that works to reduce facial hair in women by blocking a key enzyme required for hair growth. This hinders the hair from growing, though an alternative method is necessary to physically remove existing hair. When the cream is used as prescribed, it noticeably slows hair growth so removal is easier.


Pros: simple to use; may be covered by insurance; may have a greater long-term effect then some of the temporary mechanisms of hair removal
Cons: possibility of side effects or long-term health effects; only approved for use on facial and neck hair; prescription is required

Sources:

Consumer Information: Electrolysis FAQ's. American Electrology Association. 2007. Accessed February 2008. http://www.electrology.com/faq.htm

Redmond, Geoffrey. Vaniqa Cream. Polycystic Ovarian Syndrome Association. Accessed February 2008. http://www.pcosupport.org/medical/vaniqa.php

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